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Alternative names Return to top
Hemorrhage - intracerebral (hypertensive)Definition Return to top
Hypertensive intracerebral hemorrhage is bleeding in the brain caused by high blood pressure.Causes, incidence, and risk factors Return to top
Intracerebral hemorrhage can affect any person, regardless of age, sex, or race, but it is most common in older individuals.
Hypertensive intracerebral hemorrhage is caused by chronic high blood pressure (hypertension). When blood pressure has remained high for a significant period of time, blood vessel walls can change in a process called lipohyalinosis. This can lead to blockage of the vessels and leakage of blood into the brain as the constant pressure wears away at the vessels' walls.
Intracerebral bleeding associated with hypertension most commonly occurs in the tissues of the basal ganglia, pons, cerebellum, and deep white matter of the brain. Blood irritates the brain tissues, causing swelling (cerebral edema).
The blood collects into a mass (hematoma). Both the swelling of the brain tissues and the presence of a hematoma within the brain put increasing pressure on brain tissue and can eventually destroy it.
Bleeding may occur into the ventricles of the brain or into the subarachnoid space (the space between the brain and the meninges, the membranes that cover the brain), causing symptoms of meningeal irritation.
Symptoms Return to top
Symptoms vary depending on the extent of damage and the location of the bleeding. Symptoms most commonly develop suddenly, without warning, often during activity.
They may occasionally develop in a stepwise, episodic manner or in a progressive manner. There is a rapid loss of function(s) on one side of the body. These symptoms can be the same as when there is insufficient circulation to the brain (stroke).
Symptoms can include the following:
Signs and tests Return to top
Neurologic examination may indicate increased intracerebral pressure, such as swelling of the optic nerve or changes in eye movement. Localized abnormalities in brain function are detected by observing abnormal reflexes or movement.
The specific pattern of function changes may indicate the location of the problem within the brain. However, an image of the brain (CT scan or MRI) is necessary to prove the condition is due to intracerebral hemorrhage.
In order to diagnose the hemorrhage as a hypertensive hemorrhage, there must be some evidence of high blood pressure. Often the blood pressure is still very elevated when the patient is examined. Other times, there are other findings on examination or tests to suggest hypertension, such as abnormal blood vessels in the eyes or abnormal kidney function.
Tests to determine the amount and cause of bleeding include:
Treatment Return to top
Treatment goals include life support measures and control of symptoms.Expectations (prognosis) Return to top
The probable outcome is highly variable and depends on the size and location of the bleed. Recovery can occur completely, or with any level of permanent loss of brain function. Medications, surgery and treatments can have severe side effects. Death can occur rapidly despite prompt medical attention.Complications Return to top
Calling your health care provider Return to top
Intracerebral hemorrhage is a life-threatening condition requiring immediate emergency medical attention.
Go to the emergency room or call the local emergency number (such as 911) if symptoms of hypertensive intracerebral hemorrhage occur. Emergency symptoms include difficulty breathing, seizures, loss of consciousness, inability to speak and swallowing difficulties, numbness or clumsiness on one side of the body, slurred speech, or confusion.
Prevention Return to top
Treatment and control of disorders that can bring on intracerebral hemorrhage will reduce the risk. High blood pressure should be treated as appropriate. DO NOT stop taking medications unless advised to do so by your health care provider! Update Date: 7/13/2004 Updated by: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |